Hospitals' drug testing policies can have unintended consequences for women who seek care during pregnancy or after child birth, according to an investigative report published Dec. 11.
The report — published by USA Today, The Marshall Project, Reveal News and Mother Jones — is based on interviews with two dozen patients and healthcare providers, along with a review of hundreds of medical and court documents.
Four takeaways:
1. The report detailed numerous cases in which hospitals administered routine medications — such as morphine, fentanyl or ephedrine — to pregnant or laboring women and subsequently reported them to child welfare agencies when those substances appeared on drug test results for the patient or newborn. In some instances, women have faced child welfare investigations or lost custody of their children as a result.
2. Nationwide, at least 27 states legally require hospitals to alert child welfare agencies of a positive test result or baby's potential drug exposure. However, no states require hospitals to confirm these results before reporting. Mandatory reporting laws also shield physicians who report test results "in good faith" from liability, according to the report.
3. On a facility level, many hospitals do not have consistent policies for when and why drug testing occurs, often leaving it up to the interpretation of individual clinicians or overburdened social workers. In addition, some hospitals may rely on cheaper drug tests that are prone to false positives and lack appropriate reporting safeguards, such as requiring reviews of patients' medical records before sharing test results with authorities.
4. To help prevent unnecessary patient harm while still meeting their ethical and legal obligations, health systems must develop more uniform and transparent drug testing protocols. They should also improve training and education for hospital staff on when drug testing is appropriate and how to navigate reporting requirements, according to the report. For example, Somerville, Mass.-based Mass General Brigham implemented a new drug testing policy this year, instructing clinicians to test patients with their consent and only when medically necessary. The system has also ended the automatic reporting of positive results.
"How much harm to birthing people are we willing to allow? Our patients are being harmed until we can get our act together," Davida Schiff, MD, an addiction medical physician and assistant professor of pediatrics at Mass General Brigham, told the publications. "The hospitals are at fault. The clinicians are at fault. Our policies are at fault."
Read the full report here.